Care Home: Burrowbeck Grange Nursing Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well Two plans of care seen were very detailed and provided staff with clear guidance about how the needs of these people were to be met. Those living at the home or their relative had been involved in the care planning process. A review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. A wide range of risk assessments had been conducted and a variety of external professionals had been involved in the care of people living at Burrowbeck Grange to ensure that their health care needs were being met and any changes in needs wereBurrowbeck Grange Nursing HomeDS0000065247.V378035.R01.S.docVersion 5.2reflected well in the plans of care. The management of medications was good so that people living at the home were protected from any mishandling or misuse of drugs. People living at Burrowbeck Grange were treated with respect, their privacy and dignity being maintained at all times. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. A range of activities were provided and people were encouraged to maintain their leisure interests whilst living at the home. Meals were in general well managed so that those living at the home received a nutritious, well balanced diet and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. Burrowbeck Grange provided people with a comfortable and homely environment in which to live. The home was pleasant smelling throughout and effective infection control measures were in place to ensure that the health and safety of people was well protected. Staffing levels were being calculated in accordance with the assessed needs of people living at the home and robust recruitment practices were in place, which demonstrated that those living at Burrowbeck Grange were well protected. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet people’s assessed needs. New members of staff were taken through a detailed induction programme so that they were deemed competent to do the job expected of them. We received a lot of positive comments from people involved with the service, which included: ‘I am so happy living here. All the staff are very friendly and we have a good laugh’. ‘My relative is well looked after and all his needs are being met by the staff working here’. ‘It is nice working here. It is a very friendly environment’. ‘The food is very good and there is plenty going on which keeps us out of mischief, doesn’t it?’Burrowbeck Grange Nursing HomeDS0000065247.V378035.R01.S.docVersion 5.2Page 7 What has improved since the last inspection? The daily records were much improved, providing staff with clear explanations about any significant information on a day to day basis in relation to the people living at the home. The complaints procedure was freely available within the home and it was also included within the Service Users’ Guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding adults were detailed so that people knew the procedure to take should an allegation of abuse be received by the home. The finances of residents were adequately protected by the policies, procedures and practices of the home. The recruitment practices had improved since the last inspection to ensure that thorough checks had been conducted for any prospective employees so that people living at the home were safeguarded against any abusive situations. The home’s self – assessment had been completed, providing the Care Quality Commission with detailed information about the service, which was a great improvement. What the care home could do better: Information gathered about people before they were admitted to the home was not sufficiently detailed to enable staff to have a clear understanding of each individual’s needs. One plan of care seen could have been more person centred by avoiding the use of vague statements and by clearly explaining how care and support could be provided for this particular individual in accordance with their wishes. More care could have been taken to ensure that all documents were signed and dated so that staff took ownership of documentation they had completed. Care and support provided in day to day practice could always have been recorded within the plans of care to ensure staff are aware of how people’s assessed needs are to be best met. Clearer guidance could have been provided for staff about intervention required in relation to the severity of risks identified within the risk management framework. The programme of activities could be produced in a format more suitable for the people living at Burrowbeck Grange. It is recommended that both choices of meal be shown on the lunch time menu. Some surface areas could have been cleaner and the wall clocks around the home could have displayed the correct time in order to promote orientation to the time of day for people living at Burrowbeck Grange.Burrowbeck Grange Nursing HomeDS0000065247.V378035.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Burrowbeck Grange Nursing Home The Mallards North West Regional Office Scotforth Road Lancaster Lancashire LA1 4XN Lead Inspector Vivienne Morris Key Unannounced Inspection 23rd September 2009 10:00 DS0000065247.V378035.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burrowbeck Grange Nursing Home Address The Mallards North West Regional Office Scotforth Road Lancaster Lancashire LA1 4XN 01524 841876 01524 848699 jim.brown@optimacare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Optima Care Limited Mrs Valerie Francis Care Home 23 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 23 Date of last inspection 11th September 2008 Brief Description of the Service: Burrowbeck Grange Care Home is a detached property, in an elevated position, situated on the main A6 Lancaster Road. The home offers both personal and nursing care for up to 23 older people. There are 17 single bedrooms, one of which has en-suite facilities and 3 shared rooms at ground and first floor levels. The upper floor is served by a passenger lift for the less mobile and there is wheelchair access to the home. The registered providers are Optima Care Limited and Mr Syd Coombes operates as the responsible individual on behalf of the company, whilst Mrs Val Francis is the Manager in control of the day to day operation of the service. At the time of this visit, the information given to the Commission showed that the fees for care at the home ranged from £523:50 to £2510:00 for continuing care per week, with additional expenses being incurred for hairdressing, private chiropody and sundries. Communal newspapers were provided by the home. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The site visit to this service was conducted over one full day in September 2009 and this formed part of the key inspection process. The visit was unannounced, which means that the people living at the home, relatives, staff and managers did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. Comment cards were received from 15 people involved with the service and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people living there and how the quality of service provided is monitored. It also gives us some numerical information about the service. We observed the activity within the home and ‘tracked’ the care of three people living there during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at Burrowbeck Grange and involved gathering information about the service from a wide range of sources over a period of time. The Care Quality Commission had conducted one additional unannounced visit to Burrowbeck Grange during the last twelve months. This was in response to information received from an anonymous source about staffing levels, the care provided and the general management of the home. Two complaints about this service had been received by the Commission in the last twelve months. One resulted in an additional visit to the home as described above and the other was referred back to the provider to investigate using the home’s complaints procedure. What the service does well: Two plans of care seen were very detailed and provided staff with clear guidance about how the needs of these people were to be met. Those living at the home or their relative had been involved in the care planning process. A review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. A wide range of risk assessments had been conducted and a variety of external professionals had been involved in the care of people living at Burrowbeck Grange to ensure that their health care needs were being met and any changes in needs were Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.2 Page 6 reflected well in the plans of care. The management of medications was good so that people living at the home were protected from any mishandling or misuse of drugs. People living at Burrowbeck Grange were treated with respect, their privacy and dignity being maintained at all times. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. A range of activities were provided and people were encouraged to maintain their leisure interests whilst living at the home. Meals were in general well managed so that those living at the home received a nutritious, well balanced diet and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. Burrowbeck Grange provided people with a comfortable and homely environment in which to live. The home was pleasant smelling throughout and effective infection control measures were in place to ensure that the health and safety of people was well protected. Staffing levels were being calculated in accordance with the assessed needs of people living at the home and robust recruitment practices were in place, which demonstrated that those living at Burrowbeck Grange were well protected. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet people’s assessed needs. New members of staff were taken through a detailed induction programme so that they were deemed competent to do the job expected of them. We received a lot of positive comments from people involved with the service, which included: ‘I am so happy living here. All the staff are very friendly and we have a good laugh’. ‘My relative is well looked after and all his needs are being met by the staff working here’. ‘It is nice working here. It is a very friendly environment’. ‘The food is very good and there is plenty going on which keeps us out of mischief, doesn’t it?’ Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Information gathered about people before they were admitted to the home was not sufficiently detailed to enable staff to have a clear understanding of each individual’s needs. One plan of care seen could have been more person centred by avoiding the use of vague statements and by clearly explaining how care and support could be provided for this particular individual in accordance with their wishes. More care could have been taken to ensure that all documents were signed and dated so that staff took ownership of documentation they had completed. Care and support provided in day to day practice could always have been recorded within the plans of care to ensure staff are aware of how people’s assessed needs are to be best met. Clearer guidance could have been provided for staff about intervention required in relation to the severity of risks identified within the risk management framework. The programme of activities could be produced in a format more suitable for the people living at Burrowbeck Grange. It is recommended that both choices of meal be shown on the lunch time menu. Some surface areas could have been cleaner and the wall clocks around the home could have displayed the correct time in order to promote orientation to the time of day for people living at Burrowbeck Grange. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information was gathered about people’s needs before they moved in to Burrowbeck Grange. However, this was not detailed enough to ensure that the staff team could provide the care and support required. EVIDENCE: We ‘tracked’ the care of three people living at the home during the course of our key inspection. Care records showed that basic assessments had been conducted to determine people’s needs before they moved in to Burrowbeck Grange. However, more detailed information could have been gathered so that the staff team were better informed about how people moving in to the home would like their care and support to be delivered. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 11 Some documentation was incomplete and other records did not show important personal details of the person to whom they belonged. It was pleasing to see that the home’s Service Users’ Guide was available in each bedroom, so that people living at the home and their relative could refer to relevant information about the service as was required. We received ten comment cards from people living at the home. When asked if they received enough information to help them decide if this home was the right place for them to live before they moved in the majority said they did. One person living at the home said, “Val (the manager) came to have a chat with me before I came to live at Burrowbeck Grange”. When asked what the service does well the registered manager wrote on the home’s self assessment, ‘Our respite clients are afforded the same length of time and expertise. Should a service user be admitted as an emergency, we liaise with the Social Worker in order to ensure we gain sufficient prior information to assure us that we can meet their needs. We have developed our pre admission assessment to cover all aspects of physical, psychological and social needs. The prospective service user is visited by the Manager or Deputy Manager who are both qualified and experienced nurses. We spend time with the families, ward staff (if the service user is being discharged from hospital) and liaise with the GP, Social Worker and others on the multi-disciplinary team. We seek advice from specialist nurses where appropriate’. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home were being met by the practices adopted at Burrowbeck Grange. The management of medications was good and the privacy and dignity of residents’ was well maintained. EVIDENCE: We ‘tracked’ the care of three people living at the home at the time of our visit. We found that the standard of care planning varied. Two plans of care were of excellent quality, being very person centred and providing staff with a very clear picture of people’s assessed needs and how care and support was to be accurately provided in accordance with individual preferences. These plans of care had been reviewed each month and any changes in circumstances had been reflected well, so that staff were provided with up to date guidance about the needs of each individual. The importance of promoting privacy, dignity and independence was clearly evident and the individual preferences of people were well recorded, supporting the person centred approach to care for these two individuals. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 13 The third care plan provided limited information only and it contained some very vague statements which did not show a person centred approach to care. Therefore it was not evident that the individual’s preferences had always been taken into consideration, so that staff were aware of how to provide the care and support required. A wide range of risk assessments had been conducted for each individual. However, clear guidance was not provided for staff about the intervention needed to minimise risk to ensure that appropriate action was being taken. We found medications to be well managed so that people were protected from any mishandling or misuse of drugs. We noted that there was plenty pressure relieving equipment within the home so that the risk of pressure sore development was minimised. We observed some good care being delivered, but this was not always recorded in the plans of care. At the time of our visit we observed a medical emergency being dealt with promptly and efficiently. Very well done to the staff involved. Records showed that a wide range of external professionals were involved in the care of people living at the home to ensure that people’s health care needs were being met. People spoken to told us that all their needs were being met and that they were very happy living at Burrowbeck Grange. Staff were observed speaking to people living at the home in a kind and caring manner, which was pleasing to see and those spoken to said that their privacy and dignity was always respected and that they had a good rapport with staff members. A relative said, “This home has a very friendly feel to it”. One person living at the home commented. “I am treated with respect at all times. The staff are lovely and treat us very well” and another said, “The staff are all helpful and cheerful”. We received comment cards from 10 people living at the home, who all said that they usually received the care and support they needed, including medical attention. One of these people when asked what the home does well, wrote, ‘it keeps us well looked after and healthy’ and another commented, ‘it gives good support and care on days when I am feeling down or unwell’. The registered manager told us on the home’s self assessment what the service does well and gave some examples to support this information. When asked what the service has done to improve in the last twelve months she wrote, ‘We have extensively reviewed and improved the quality of our documentation. We have introduced a new Infection Control Manual. We continue to provide training for our team to ensure their practice remains current. We communicate better and by more diverse methods as a result of the Investors in People process’ and when asked what the service could do better she told us, ‘Our care plans could be more person centred and the delegated focus group is working towards this’. Five staff members sent us comment cards, who all said that they were given enough information about the needs of people they supported and cared for, such as in the care plan. One of these people when asked what the service does well wrote, ‘the way the care plans are organised is very helpful for the workers and it is important for the smooth running of the home’ and another commented, ‘the home provides excellent care for all the residents’. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 14 Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home encouraged people to have a flexible life style and supported those living at the home to maintain their hobbies and leisure interests whilst living at Burrowbeck Grange. Visitors were made to feel welcome and people were supported to have an independent person to act on their behalf, should they wish to do so. EVIDENCE: Two activity co-ordinators were employed at Burrowbeck Grange who were responsible for planning, organising and implementing leisure activities so that people could continue to maintain their interests whilst living at the home. The programme of activities was displayed in the home but it is suggested that it be produced in a more accessible format so that it is more colourful and interesting for the people living at Burrowbeck Grange. On arrival to Burrowbeck Grange some residents were enjoying a game of soft ball in the lounge and later others were enthusiastically playing carpet bowls and were eager to win the competition. The atmosphere was very friendly and relaxed, providing people with comfortable surroundings in which to live. During the afternoon a general knowledge quiz was enjoyed by those wishing to participate and gentle ball games were provided for the Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 16 less able in a separate lounge area of the home. The Service Users’ Guide referred to people being given the same opportunities irrespective of their disability, culture, gender or religion and our observations supported this information. A variety of events were evident such as a wild-west party, an outing to the zoo, an Irish day with Irish stew being on the menu and a visit from the birds of prey sanctuary. A photograph gallery was displayed of the various activities, which included residents, friends, relatives and staff, which was pleasing to see. When asked if there were activities arranged that people could take part in if they wanted to the responses on the comment cards from those living at the home varied. The majority said that there were usually suitable activities arranged that they could join in if they wanted to do so. Those spoken to on the day of our visit were quite satisfied with the range of activities provided. One person who was sitting in her room said, “I am very happy living here and activities are provided, but I prefer not to join in. I am pleased that I am not forced to join in and that I can choose for myself”. The Service Users’ Guide and relevant policies and procedures told people about visiting arrangements and how they may access the local advocacy service should they want an independent person to act on their behalf. Information about advocacy services was freely available within the home to help people make decisions. One visitor told us that she was satisfied with the care and support provided for her relative and that she felt very comfortable visiting the home and another commented, “The staff are all very friendly”. The menu was clearly displayed and although only one choice was shown for the lunch time meal records showed that two choices were offered to people living at the home. It is recommended that both choices be included in the menu so that people can decide in advance about which option they would prefer. We observed lunch being served. The dining tables were pleasantly set with nice table decorations and table cloths, making the dining experience an enjoyable one for those living at the home. Meals were well presented and specialised adaptations were provided as required to aid in nutrition and to promote independent eating. Care records identified people who required specific utensils for eating so that they could remain as independent as possible, which was good practice. Discreet protection for clothing was supplied for those requiring it and staff were observed offering people assistance with their meals in a discreet and unobtrusive manner. One member of staff was heard discussing one person’s food preferences with them, which was in accordance with their plan of care. We sampled the food. It was very well presented, nutritious and tasty. People appeared to be enjoying their meals and those spoken to told us that they thoroughly enjoyed the food served at Burrowbeck Grange. One person said, “I don’t like broccoli but I am always given an alternative vegetable when broccoli is on the menu” and another commented, “no matter what we get for our meals it is always exceptionally good”. We were told by one resident that the manager had specially bought in her preferred hot beverage because it wasn’t normally something that was offered at the home. She added, “So I can have horlicks with my jam and bread before I go to bed, which I love”. The registered manager provided us with a lot of information about how the service meets people’s daily life and social activity needs and gave us some good examples of how this Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 17 was achieved. When asked what improvements were planned for the next twelve months she wrote on the home’s self-assessment, ‘We are planning a secure sensory garden for our service users with Dementia and will be enlisting the services of a landscape gardener to plan this. We will continue to listen to the views of our service users and their significant others and constantly strive to improve further’. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 AND 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Burrowbeck Grange were protected by the robust policies, procedures and practices adopted by the home and complaints were well managed. EVIDENCE: The home’s complaints procedure was clearly displayed within the home and it was included in the Service Users’ Guide so that people were aware of how to make a complaint should they wish to do so. A system was in place for recording any complaints received, but it is recommended that a numbered page book be used for this purpose to avoid the possibility of loose leaf pages being mislaid or removed. No complaints had been recorded by the home in the last twelve months. The majority of people who sent us comment cards felt there was someone they could speak to if they were not happy. However, four of these people said that they would not know how to make a formal complaint if they needed to do so, although the complaints procedure was freely available within the home. Those spoken to at the time of our visit told us that they would speak to Val, the manager if they had any concerns about anything at all. Policies and procedures were in place at the home in relation to the protection of vulnerable adults so that staff would know what to do if they had any concerns about the Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 19 welfare of anyone living at Burrowbeck Grange. These policies and procedures had been reviewed and updated so that staff were provided with current information. All five staff members who sent us comment cards and those spoken to on the day of our visit said that they would know what to do if they were concerned about the treatment of someone living at the home. A good percentage of staff had completed relevant training in the protection of vulnerable adults and we were told that more training had been arranged for the week following our visit. When asked how the service has improved in the last twelve months the registered manager wrote on the home’s self-assessment, ‘we have recognised that our service user group has changed and that legislation has changed in the form of the Mental Capacity Act and Deprivation of Liberty. We will incorporate the additions to the new standards into our working practice and policies, updating future amendments as appropriate. There have been fewer complaints received’. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was maintained to a good standard and was suitable for the needs of people living there. EVIDENCE: During the course of our inspection we toured the premises and found the environment to be comfortable, homely and in general, clean and pleasant smelling, although some surface areas were quite dusty and in need of cleaning. It was pleasing to see that the bedrooms were individualised and contained people’s personal belongings. The communal areas of the home were pleasantly decorated and suitable for those living at Burrowbeck Grange. However, we noted that many of the wall clocks around the home were showing incorrect times, which did not promote orientation to time for the people living at the home. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 21 Those spoken to were happy with their bedrooms and the Service Users’ Guide told people that bedrooms may be personalised with individuals’ own belongings. Infection control policies and procedures were in place at the home and clinical waste was being disposed of correctly to ensure that the risk of cross infection was minimised. When asked if the home was fresh and clean eight of the ten people who lived at Burrowbeck Grange and who sent us comment cards said it always was and two told us it usually was. One person wrote, ‘the home is clean and tidy’ and a staff member commented. ‘I think the home’s standards of cleanliness and hygiene are very good’. When asked what the service does well the registered manager told us, ‘We provide a clean, homely and comfortable environment for our service users. The home is set in beautiful gardens and is a beautiful old building with much character. Our service users are encouraged to personalise their rooms and, where they are able, choose colours and fittings when decorating or refurbishment takes place. Emphasis is on safety and our Health and Safety Representatives carry out monthly audits’. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs were being met by the number, qualifications, experience and skill mix of staff members and those living at Burrowbeck Grange were appropriately safeguarded by the robust recruitment practices adopted by the home. EVIDENCE: At the time of our visit there were 20 people living at Burrowbeck Grange. The staff rota clearly showed which staff were on duty at any time of the day or night. We found that there was a good ratio of staff to residents and that the needs of people living at the home were being appropriately met. It was evident that some agency staff were used. However, these workers were provided with an easy reference guide about any important aspects of the home and any significant details about the people living at Burrowbeck Grange, which was considered to be very good practice. Evidence was available to show that staffing levels were being calculated in accordance with the assessed needs of people living at the home. This ensured that care and support was provided as was required by the number and skill mix of staff on duty at any one time. Six of the ten people who sent us comment cards said that staff were always available when they were needed and the other four said that they usually were. All five staff Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 23 members who sent us comment cards felt that, in general, there were enough staff on duty to meet the individual needs of all those who use the service. At the time of our visit records showed that there were 25 care staff employed at Burrowbeck Grange, 14 of whom had achieved a recognised qualification in care, with a further ten in the progress of completing this award showing that the home was working towards a high percentage of care staff being appropriately qualified. We examined the personnel files of two staff members employed earlier in the year and found that robust recruitment practices were adopted by the home to ensure people living at Burrowbeck Grange were thoroughly safeguarded. Induction records were available on the staff files examined, which showed that new staff were provided with all relevant information about the service on commencement of employment. A training matrix was in place at the home, which showed that a wide range of mandatory training was provided as well as training specific to the needs of people living at the home. A variety of training certificates were displayed within the home showing that staff had attended a range of training courses. Staff spoken to told us that Optima Care promoted staff training well and one person said, “Oh Gosh. There is absolutely loads of training available for us”. We spoke to one care worker who was thrilled to have been short listed for the training providers’ award ‘learner of the year’, which was commendable. When asked what the service does well the registered manager told us, ‘we invest heavily in training to ensure our team feels empowered and valued. This enables us to select a good skill mix. We reward achievements which increases motivation. Our care staff are trained to NVQ 2; several have achieved level 3 and one level 4. Our newer starters are already working towards their qualification. Our senior team leader is working towards a Leadership and Management in Care award’. When asked what improvements are planned within the next twelve months the registered manager wrote on the home’s self-assessment, ‘we recognise the individuality and outside influences on our staff members and will continue to respond positively, where possible, to their requests for changes to their working environment and their conditions. We are looking at the possibility of involving our service users in interviewing and in recruitment decisions. We will implement a core competency framework in line with Agenda for Change’. All five staff members who sent us comment cards said that their employer carried out checks, such as Criminal Record Bureau (CRB) disclosures and references before they started work at the home and that their induction covered everything they needed to know to do the job when they started. These staff members told us that they were being given training which was relevant to their role, which helped them to understand and meet the needs of people and which kept them up to date with new ways of working. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was being well managed by a competent and experienced person and the quality of service provided was closely monitored to ensure that people received the care and support they expected. The health, safety and welfare of those living at Burrowbeck Grange was protected and people’s finances were safeguarded by the robust policies, procedures and practices adopted by the home. EVIDENCE: The home’s self-assessment produced by the manager of Burrowbeck Grange was well written providing the Care Quality Commission with a lot of detailed information about the service. The manager of Burrowbeck Grange, Val Francis holds relevant qualifications to manage the home and has several years experience in the management of care services. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 25 She is registered with the Care Quality Commission and continues to update her knowledge and skills whilst managing Burrowbeck Grange. The manager of Burrowbeck Grange was on a training course at the time of our arrival, but she returned when she knew we had visited the home, so that she could be involved in the inspection process, which showed her interest and commitment to the service. The Responsible Individual representing the company, Optima Care and the Clinical Services Manager were also on site at the time of our key inspection. Staff spoken to said that they felt supported by the management of the home and it was clear that the manager had an open door policy so that people could discuss any issues with her in private. Staff members who sent in comment cards all said that their manager gives them enough support and meets with them to discuss how they are working. They also indicated that the ways information was shared about people they supported worked well. One person wrote, ‘the home is run very well. It puts individual needs first’. There were a variety of systems in place to monitor the quality of service provided so that any strengths or areas in need of improvement could be identified and addressed accordingly. These systems included inspection reports by the Responsible Individual, minutes of any meetings held so that all relevant parties could review the discussions taking place, auditing of the service by an external professional body, an annual development plan and a wide range of audits so that the quality of service could be closely monitored. Surveys had been circulated and returned by people using the service or their relatives, the results of which had been plotted in pie charts so that the outcome areas for people living at Burrowbeck Grange could be easily seen. We were told that the home did not deal with people’s finances and therefore this standard was not assessed on this occasion. A good percentage of staff had completed Health and Safety training, which was mandatory for people working at Burrowbeck Grange and a variety of relevant policies and procedures were in place. In addition there were periodic Health and Safety meetings held so that any relevant issues could be discussed and addressed as required. A random selection of certificates were examined, which showed that systems and equipment used by staff and people living at the home had been serviced at appropriate intervals to ensure they were safe for use. However, there were a few items we noted needed attention. One of the bedroom doors slammed shut and therefore needed adjusting in order to prevent any injury to people using this room. There were some external preparations and toiletries easily accessible on bedroom shelves, which could cause harm if ingested. This practice should be reviewed considering the needs of people living at Burrowbeck Grange. A variety of assessments had been conducted so that any risks were identified and strategies implemented as was required in order to reduce the possibility of injury to staff or people living at the home. In addition a wide range of internal checks were conducted at regular intervals to ensure the home provided a safe environment for people to live in. We checked random hot water outlets throughout the home, which were all within acceptable temperature guidelines. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 26 When asked how the home had improved in the last twelve months the registered manager wrote on the home’s self-assessment, ‘we have updated policies and procedures, extended the range and produced new manuals. As a company, we are in the process of compiling care planning guidance, based on recognised guidelines, to assist our qualified staff. We have made our policies and procedures more ‘user friendly’. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(b)15 (1) Requirement The plans of care must always provide clear guidance for staff as to how people’s assessed needs are to be accurately met in accordance with their individual preferences. (Timescale of 15/08/09 not met) The registered person must always ensure that unnecessary risks to the health or safety of people living at the home are identified and so far as possible eliminated. This includes making sure that any doors within the home do not ‘slam’ shut and any creams, lotions and toiletries are stored appropriately. Timescale for action 30/11/09 2. OP38 13 (4)(c) 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations More detailed information should be obtained about people’s needs before they move in to Burrowbeck Grange. Care should be taken DS0000065247.V378035.R01.S.doc Version 5.3 Page 29 Burrowbeck Grange Nursing Home 2. 3. 4. 5. 6. 7. OP7 OP8 OP8 OP12 OP15 OP16 to ensure that all documents are signed and dated so that staff take ownership of documentation they have completed. Vague terminology should always be avoided so that a more person centred approach is consistently adopted by the care planning process. Staff should be provided with clear guidance about what intervention is required in relation to the severity of risks identified. Care and support provided in day to day practice should always be recorded within the plans of care to ensure staff are aware of how people’s assessed needs are to be best met. The programme of activities could be produced in a format more suitable for the people living at Burrowbeck Grange. It is recommended that both choices of meal be shown on the lunch time menu. It is recommended that complaints be recorded in a numbered page book to avoid the possibility of loose leaf pages being mislaid or removed. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 30 Care Quality Commission North West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Burrowbeck Grange Nursing Home DS0000065247.V378035.R01.S.doc Version 5.3 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!